Ankle Arthroscopy and Ligament Reconstruction

What is ankle arthroscopy and ligament reconstruction?

Ankle arthroscopy is a highly effective, and minimally-invasive, procedure that provides a clear view of your ankle joint for treatment and diagnosis. It involves the introduction into the joint of a very small fibre-optic arthroscope, equipped with a camera, which allows the surgeon to visualise the internal architecture of the ankle.

Indications and contraindications for ankle arthroscopy and ligament reconstruction

Ankle arthroscopy is employed for evaluation, diagnosis and treatment of painful symptoms in the ankle, and can be used for:

Fracture treatment: Arthroscopy, in combination with open techniques, can help acheive proper bone and cartilage alignment during fracture repair.

Partial synovectomy: involves the partial removal of segments of the synovium.

Debridement: the removal of torn cartilage, bone fragments, or the treatment of joint surfaces.

Ligament repair: to stablise the ankle.

Anterior ankle impingement: removal of inflamed tissue at the front of the ankle joint, as well as any bone spurs.

Posterior ankle impingement: removal of inflamed tissue at the back of the ankle.

Diagnosis: through direct visualisation of the joint.

 

Contraindications for ankle arthroscopy include: 

Advanced ankle arthritis.

Severe active infection.

Severe coagulopathies, resulting in excessive bleeding.

Extensive bone loss in the ankle.

Benefits and complications of ankle arthroscopy

Benefits

  • Allows precision assessment and treatment formulation for conditions which can’t be reliably diagnosed radiographically.
  • Less painful than an open procedure.
  • Faster recovery compared to an open procedure.
  • Reduced scarring.

Known complications

  • Permanent nerve damage, resulting in sensory or motor deficit.
  • Superficial or deep infection.
  • Vascular injury and bleeding.
  • Pain.
  • Deep Vein Thrombosis (DVT)

The surgery

Preparation prior to surgery

  • You will receive a thorough health assessment: including medical history. You may be advised to modify certain lifestyle factors and you may be referred to another specialist. You may be asked to stop taking certain medications as your surgery date approaches. X-rays, CT scans, and MRIs will be used to evaluate your condition and plan your surgery.  
  • Skin and bowel preparation: On the evening before your surgery, you will be asked to wash your leg using the sponge provided at your pre-admission clinic. A skin test may be administered if an iodine allergy is suspected. You will also be provided medicine to help you evacuate your bowels prior to surgery.
  • Patient education: if neccessary, you may speak with a physiotherapist who can advise you on post-operative mobility. 

 

On the day of the surgery

  • You will be asked to complete your surgical paperwork and will meet with the anaesthetist.
  • The surgical site will be prepared.
  • You will be administered general or regional anaesthesia.
  • A tourniquet is placed around the thigh, and a small incision will be made over the ankle through which the arthroscope will be inserted
  • Fluid will be pumped into the joint through the arthroscope to maintain a clear field of view and control bleeding. 
  • Steps will be taken to repair or remove components of the ankle as required, e.g. trimming bone spurs or removing inflamed tissue.
  • Local anaesthetic will be administered to the wound site. 
  • The wound will be sutured and dressed.

 

After your surgery

  • Wound care: Bandages can be removed after 24 hours, and a waterproof dressing placed over the wound. 
  • Pain and swelling: You may experience mild to moderate pain in the ankle. You will be prescribed painkillers to manage these symptoms. Inflammation can be controlled by icing (15 minutes per hour maximum) and elevation during the first week.
  • Mobilising: this will be guided by the degree of surgical intervention. You may walk provided you can do so without pain. Strengthening exercises may be provided to help improve recovery. 
  • Aftercare: a follow-up appointment will be scheduled within seven to ten days of your surgery, to assess recovery and remove your sutures. 

Concerns

If you are concerned about your pain level, or develop significant bleeding, fever or redness around the surgical site, please contact us immediately. For after-hours support, contact the hospital at which your surgery was completed. They will contact Prof. Al Muderis on your behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000